Infection Prevention and Control in Commissioning Josie McHale-Owen

Infection Prevention 1wte appointment – Countywide hosted by SWCCG -1 st July 2013 Maintain previous contract with H&C Trust Improve on communication and sharing of intelligence (IPC) within health economy – seamless service – consistency in information for patients and staff.

Expectations Health economy vision for improving IPC Shared learning from incidents and surveillance of infection. Reduce HCAI’s Post Infection Review of MRSA Bacteraemia and CDI Working together – PHE, secondary and primary care, nursing, residential & home care, public engagement Improved quality – patient focused

So Far HE Strategy to reduce the risk of HCAI – draft to be presented at IPS Forum 17 th October MRSA – PIR on all cases within 14 working days 7 within Worcestershire 4 in residents SWCCG – 3 apportioned to different hospitals 1 apportioned to SWCCG – community acquired, 1 apportioned to WFCCG and 3 apportioned to WHAT. CDI – Challenging targets for acute trusts and CCG’s – expect to be within trajectory for end of q2.

Winter Plan Improved communication and strong communication cascade with H&CT and WHAT. Outbreak Information sharing across health and social care and neighbouring counties. Outbreaks in residential and care homes - led by PHE and supported by CCG – daily contact Monday-Friday Daily outbreak update of all areas affected issued to provider organisations to enable high risk patients to be identified promptly. Sip Not Drip – campaign – to start October – investment in educational tools and working documents for all SW Nursing Homes – plan to develop theme and extend Countywide th October – H&CT facilitating training day for care home staff launch ‘sip not drip’ D&V pathway – October 2013 Patient and resident information leaflet – October 2013 Information and links on CCG home page

CDI TARGETS Responsible Provider 2012/13 Target 2013/14 Target South Worcestershire CCGN/A89 Redditch & Bromsgrove CCGN/A42 Wyre Forest CCGN/A36 NHS Worcestershire (Sum of 3 CCGs) Worcestershire Acute Hospitals Trust 5248 Worcestershire Health and Care Trust 1210

Statistical Breakdown of Position based on Local and HCAI database with straightline trajectory *R&B loaded for year start Responsible Provider Quarter 1 Target Actual Position South Worcestershire CCG22 Redditch & Bromsgrove CCG12 *12 Wyre Forest CCG98 (Sum of 3 CCGs)42 Worcestershire Acute Hospitals Trust1216 Worcestershire Health and Care Trust21

Quality IPCN attends assurance visit in provider organisations and contracted services. Support organisations with information, tools and guidance on best practice – critical friend. Reviews SI’s related to IPC and HCAI’s Working collaboratively with H&CT to ensure timely feedback on all CDI cases to GP’s and share learning across primary care.

Recent CQC IPC Reviews in Primary Care Wanted evidence of recent IPC Audits One CQC inspector reported that the practice did not have a DIPC – the guidance for Primary Care clearly states that a DIPC is not required in Primary Care – but you do need a designated lead Pleasant, but spent a lot of time checking dates on sterile items in clinical room If recommendations made by previous audits by IPCN’s were not implemented noted as noncompliant – even when the recommendations clearly said in the event of refurbishment ….’ The guidance for primary care states ‘an annual IP statement’ – CQC expected one Hand hygiene audits – wanted evidence of these - simple tools and practical hand hygiene education may help. Policies – if you use someone else’s make sure they are personalised to the practice – ‘it was noted that they were using another PCT’s but that there was no statement to reflect that the practice had assessed them to be safe to use in their environment’. Governance structure was criticised – if action plan agreed you need named leads, realistic timescales, evidence of review, exception reports if plans change, evidence of discussion within practice at meeting. Neighbouring CCG is advising to have an annual programme of work PAT testing and maintenance of equipment Cleaning schedules of equipment – clinical equipment ensure instruction for decontamination is written down and is evidenced back to the manufacturers guidance. COLD CHAIN

. Systems to manage and monitor the prevention and control of infection. These systems use risk assessments and consider how susceptible service users are and any risks that their environment and other users may pose to them Designated person to lead on IPC Infection control programme – IPC measures needed in the practice Policies procedures and guidance – how is it monitored and kept up to date Training – induction and on-going Record of names and contact details of health practitioners who can provide advice. Annual statement – infection incidents, audits risk assessments training and policy reviews

Provide and maintain a clean and appropriate environment in managed premises that facilitates the prevention and control of infections Designated lead for cleaning and decontamination Premises to be furnished taking into account national guidance and rooms with specialist functions Environmental cleaning policy should specify how to clean all areas fixtures and fittings – and specify what products to use. A specific cleaning specification for minor ops rooms.

Provide suitable accurate information on infections to service users and their visitors Information about your approach to prevention and control of infection, staffs roles and responsibilities and who people should contact with concerns about infection prevention and control of infection. Have available up to date information on current infections such as influenza

Provide suitable accurate information on infections to any person concerned with providing further support or nursing/ medical care in a timely fashion. Primary medical care practitioners are key providers of information to other health and social care providers and to public authorities, both concerning individual users and community outbreaks.

Ensure that people who have or develop an infection are identified promptly and receive the appropriate treatment and care to reduce the risk of passing on the infection to other people The primary medical care practitioner will provide initial advice and treatment when a service user under their care develops an infection and will assess any potential communicable disease control issues. – in most cases further action will not be required – if required the primary medical care practitioner may consult with the designated source of IPC advice / and or local public health team or refer to speacialist care – such as smear positive TB, infectious diseases such as chicken pox measles or norovirus or suspected outbreaks.

Ensure that all staff and those employed to provide care in all settings are fully involved in the process of preventing and controlling infection. Ensure that every person working in the practice including agency staff external contractors and volunteers understand the need to prevent and control infections including those associated with invasive medical devices.

Secure adequate access to laboratory support as appropriate Access to diagnostics microbiology and virology laboratory's service which operates according to the requirements of relevant national accreditation bodies.

Have and adhere to policies, designed for the individual’s care and provider organisations, that will help to prevent and control infections. Listed policies and assurance criteria – including Standard Infection Prevention and control precautions, aseptic technique – see table in the document.

Ensure, so far as is reasonably practicable, that care workers are free of and are protected from exposure to infections that can be caught at work and that all staff are suitably educated in the prevention and control of infection associated with the provision of health and social care. Access to occupational health services

What next ……. Easy wins – Education and training Ultra violet light box - practical Environmental Audit Health and Care Trust - tools Evidence folder Decontamination guidance